Painful swollen thigh in a patient with poorly controlled diabetes

A 55-year-old woman with an 8-year history of type 2 diabetes was admitted to the cardiology department with symptoms suggestive of congestive cardiac failure. She had also had severe left thigh pain for the past 12 days.

She was found to have had a muscle infarction (diabetic myonecrosis), which is an unusual complication of diabetes that is under-diagnosed as physicians are often unfamiliar with this condition. The clinical presentation is very distinct with abrupt onset of pain and swelling of a limb, usually the thigh and less frequently the calf. Diagnosis is based on clinical features supported by characteristic magnetic resonance imaging (MRI) findings. A high index of clinical suspicion is needed so as to avoid invasive diagnostic techniques and unnecessary surgical intervention.

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Fig 1.

MRI scan of the transverse section of the left mid thigh and T2 fat saturation sequence. (a) shows muscle oedema and swelling, (b) shows subcutaneous oedema and (c) shows muscle atrophy. MRI = magnetic resonance imaging.